Magnolia Grove Healthcare
NPI #1710179395 in Gulfport, Mississippi
Provider Information
- NPI Number
- 1710179395
- Entity Type
- Organization
- Organization Name
- Magnolia Grove Healthcare
- Primary Specialty
- Clinic/Center - Primary Care
- Enumeration Date
- Aug 16, 2007
- Last Updated
- Aug 16, 2007
Practice Location
- Address
- 4333 15TH ST STE A
- City
- Gulfport
- State
- Mississippi
- ZIP Code
- 39501-2525
- Phone
- (228) 863-4000
Authorized Official
- Name
- TRACEY DECENA
- Title
- OFFICE MANAGER
- Phone
- (228) 863-4000
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Primary Care — Primary Care |
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